INTRODUCTION & OBJECTIVES: Midurethral slings are currently the treatment of choice for women with stress urinary incontinence(SUI) . The long term outcomes of TVT had been approved . This study was to prospectively compare the efficacy and safety of transobturator tape (TOT) with that of tension free vaginal tape (TVT) procedures for the treatment of women with stress urinary incontinence 5 years after tape insertion.

MATERIAL & METHODS: Between June 2003 to June 2012, 97 female patients with SUI
were randomly distributed to two groups ; group I (TVT) included 49 patients and  group II  (TOT ) included 48 patients . All patients underwent preoperative evaluation including case history, physical examination (general,urological,neurological and urogynecological ) and urine stress test, urine analysis and culture to exclude UTI, and urodynamic tests including water cystometry, stress urethral pressure profile test and abdominal leak point pressure. 
 The operative data such as operative time, estimated blood loss, hospital stay and any perioperative complications were recorded. All patients were evaluated at 3 months , 6 months and yearly .
At each follow up visit, the patients were examined for complications ,voiding and storage
symptoms (by standard questionnaire ),the state of continence , urodynamics . An Arabic version of the SEAPI -QMM quality of life index was used to assess the outcome in the two groups.The criteria of cure of SUI  were  a negative stress test , a negative 24-h pad test and no other treatment for SUI .

RESULTS: From the 98 patients eligible for the study, 85 patients completed the follow up ; 44 in group I (TVT) and 41 in group II(TOT) . No significant difference was noticed between the two groups as regard the mean operative time , intraoperative blood loss, hospital stay , perioperative and postoperative complications.The cure rate was 84% in TVT group and 82% in TOT group with no statistical difference between groups . Urodynamics showed that the mean of abdominal leak point pressure and urethral closure pressure were markedly improved in both groups  and this improvement was  maintained for 5 years later in group I whereas in group II a significant decline in comparison with group I was noticed after 1 year . 
The mean of objective SEAPI score showed a significant improvement in both groups and this was maintained for the  five years in TVT group  but in TOT group  it marginally increased after one year later.

The mean of objective SEAPI score showed a significant improvement in both groups and this was maintained for the  five years in TVT group  but in TOT group  it marginally increased after one year later.

CONCLUSIONS: After 5-year follow up both treatment modalities are highly effective and safe for treatment of women  with SUI .The improvement in the urodynamic function and quality of life index score were better maintained for TVT patients